Cheng Chloe, Donovan Gemma, Al-Jawad Naseer, Jalal Zahraa
School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Generated Health Ltd, Mercury House, 117 Waterloo Road, London, SE1 8UL, England.
J Pharm Policy Pract. 2023 Jun 29;16(1):81. doi: 10.1186/s40545-023-00582-9.
Heart failure is an ever-growing contributor to morbidity and mortality in the ageing population. Medication adherence rates among the HF population vary widely in the literature, with a reported range of 10-98%. Technologies have been developed to improve adherence to therapies and other clinical outcomes.
This systematic review aims to investigate the effect of different technologies on medication adherence in patients with heart failure. It also aims to determine their impact on other clinical outcomes and examine the potential of these technologies in clinical practice.
This systematic review was conducted using the following databases: PubMed Central UK, Embase, MEDLINE, CINAHL Plus, PsycINFO and Cochrane Library until October 2022. Studies were included if they were randomised controlled trials that used technology to improve medication adherence as an outcome in heart failure patients. The Cochrane Collaboration's Risk of Bias tool was used to assess individual studies. This review was registered with PROSPERO (ID: CRD42022371865).
A total of nine studies met the inclusion criteria. Two studies showed statistically significant improvement in medication adherence following their respective interventions. Eight studies had at least one statistically significant result in the other clinical outcomes it measured, including self-care, quality of life and hospitalisations. All studies that evaluated self-care management showed statistically significant improvement. Improvements in other outcomes, such as quality of life and hospitalisations, were inconsistent.
It is observable that there is limited evidence for using technology to improve medication adherence in heart failure patients. Further studies with larger study populations and validated self-reporting methods for medication adherence are required.
心力衰竭在老年人群中的发病率和死亡率日益上升。文献中报道的心力衰竭患者的药物依从率差异很大，范围为10%-98%。已开发出多种技术来提高治疗依从性和改善其他临床结局。
本系统评价旨在研究不同技术对心力衰竭患者药物依从性的影响。同时也旨在确定这些技术对其他临床结局的影响，并探讨其在临床实践中的应用潜力。
本系统评价使用了以下数据库：英国 PubMed Central、Embase、MEDLINE、CINAHL Plus、PsycINFO 和Cochrane图书馆，检索截至2022年10月的文献。纳入的研究须为随机对照试验，且将使用技术改善心力衰竭患者的药物依从性作为一项结局指标。采用Cochrane协作网的偏倚风险工具对各研究进行评估。本评价已在PROSPERO注册（注册号：CRD42022371865）。
共有9项研究符合纳入标准。两项研究显示，各自干预措施实施后，药物依从性有统计学意义的显著改善。八项研究在其测量的其他临床结局（包括自我护理、生活质量和住院情况）中至少有一项具有统计学意义的结果。所有评估自我护理管理的研究均显示有统计学意义的改善。生活质量和住院情况等其他结局的改善情况并不一致。
可以看出，关于使用技术改善心力衰竭患者药物依从性的证据有限。需要开展更大规模研究人群的进一步研究，并采用经过验证的药物依从性自我报告方法。
